The degree of self-referral for SPECT imaging in the utilization of Nuclear Cardiology services is being
underestimated. Furthermore, these services are being utilized by internists and GPs in addition to
cardiologists. In many instances these physicians use the services of unlicensed mobile companies that
essentially provide turn-keys services allowing non credentialed physicians to perform and bill Medicare
on a global basis for these services from their office setting. They have attained accreditation status by
utilizing the credentials of other physicians who assist and facilitate the performance of the services and
sharing in the Medicare and third party reimbursement. These self referring physicians have no financial
risk in these lease arrangements with the mobile company. Many arrangements like this persist and are
in direct violation of many state and federal statues. Finally, these arrangements abuse the Medicare
system and are not performed in adherence to the appropriateness of use criteria..

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